*Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia; and †The Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia.
Ann Surg. 2015 Feb;261(2):304-8. doi: 10.1097/SLA.0000000000000581.
This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges.
A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surgical care. It identifies system or process errors, trends in deficiency of care and helps develop strategies to reduce deaths in the surgical arena.
A standardized tool is used to systematically collect data after every surgical death. Patient details are reviewed by a peer surgeon (and in certain cases a second) to identify issues with patient management and hospital processes. The treating surgeon is then offered confidential feedback and alternate views on patient management.
From January 2009 to December 2012, 19,096 deaths were reported to the ANZASM. Eighty-six percent of the audited deaths occurred in patients requiring an emergency admission. Significant criticism of patient care was reported in 13% of cases with 16% of clinical issues perceived to be preventable. Western Australia, which first began the audit process, has shown a 30% reduction in surgical deaths.
Nationwide mortality audits are a useful and worthwhile exercise. Recommendations identified in the audit reports direct educational workshops and seminars to address these issues. They allow Departments of Health to make informed decisions in their hospitals. Through this model, and the lessons learnt, we would encourage other countries planning to set up their own audits to follow a similar concept.
本文概述了澳大利亚和新西兰外科手术死亡率审计（ANZASM）的形成过程，并介绍了其目标、治理结构、运作方式和面临的挑战。
对外科手术死亡率进行全国范围的审计，可以全面了解需要外科治疗的患者的主要死亡原因。它可以发现系统或流程错误、护理不足的趋势，并有助于制定策略来减少外科领域的死亡。
使用标准化工具系统地收集每例外科死亡后的数据。由同行外科医生（在某些情况下为第二位）审查患者详细信息，以确定患者管理和医院流程方面的问题。然后，为治疗外科医生提供有关患者管理的机密反馈和替代观点。
从 2009 年 1 月至 2012 年 12 月，ANZASM 报告了 19096 例死亡。经审核的死亡中有 86%发生在需要紧急入院的患者中。在 13%的病例中报告了对患者护理的重大批评，其中 16%的临床问题被认为是可以预防的。首先开始审计程序的西澳大利亚州已经显示外科手术死亡率降低了 30%。
全国范围内的死亡率审计是一项有用且值得进行的工作。审计报告中提出的建议指导了教育研讨会和研讨会，以解决这些问题。它们使卫生部门能够在其医院中做出明智的决策。通过这种模式和吸取的经验教训，我们鼓励其他计划建立自己的审计的国家效仿类似的模式。
